Dr. Silliman is a geriatrician and clinical epidemiologist whose research over the past 20 years has highlighted age-associated disparities in cancer treatment, related in large part to the quality of patient- physician communication. Because of the critical role of comorbidity in the care of older cancer patients, her investigative work has also explored alternative methods of its measurement. Finally, her work has considered the implications of treatment variations on a range of health outcomes: (1) general and breast cancer-specific emotional health;(2) upper body function;and (3) breast cancer recurrence and mortality. Her currently funded R01s are designed to: (1) characterize the separate and joint effects of treatment, tumor, and patient characteristics on breast cancer-specific outcomes in the HMO setting;and (2) examine the relationships among breast cancer and its treatment, age-related comorbidities and functional impairments, and health outcomes in long-term older breast cancer survivors in the fee-for-service setting. During the K05 renewal period, Dr. Silliman proposes to study the impact of multiple morbidities on cancer care and outcomes. Specifically, she will (1) expand the scientific evidence that defines optimal breast cancer care for older women with multiple morbidities;(2) develop new measurement strategies and applications to improve our understanding of multiple morbidity as an independent variable, confounder, and effect modifier of breast cancer treatment and outcomes;(3) develop a research database infrastructure to support studies of cancer care quality and effectiveness among older cancer patients with multiple morbidities;and (4) develop young investigators whose research focuses on cancer prevention and control in older adults. New research during the funding period will compare the care for incident and prevalent non- breast cancer comorbid conditions, specifically quality of care and health care utilization;adherence to preventive health care strategies;and end of life care received by older breast cancer survivors and an age and comorbidity-matched comparison group. Relevance: Dr. Silliman has successfully applied the basic science of epidemiology to the cancer epidemic in older adults. She is positioned to enrich our knowledge of cancer prevention and control in older adults and to develop the next generation of cancer control scientists.